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Alex R. Kemper, MD, MPH, MS; Lisa M. Keating, CO; Jorie L. Jackson, CO; Erika M. Levin, MD

Arch Pediatr Adolesc Med. 2005;159:435-439.

Background  Monocular autorefraction is a newly available technology for vision screening that has been advocated to test young children. Such devices automatically determine the refractive state of each eye, but cannot directly detect amblyopia or strabismus.

Objective  To compare the results of a commercially available monocular autorefractor (SureSight; Welch Allyn Medical Products, Skaneateles Falls, NY) with findings from a comprehensive eye examination for significant refractive error, strabismus, and amblyopia.

Methods  Children 5 years and younger who were new patients attending a pediatric ophthalmology clinic were tested with the monocular autorefractor without dilation and underwent a comprehensive eye examination that included dilation.

Main Outcome Measures  The proportion of children who could be tested and the sensitivity and specificity of the screening.

Results  Of the 170 children enrolled (age, <3 years, n = 80; age range, 3-5 years, n = 90), 36% had abnormal eye examination findings. Most (84%) children 3 years or older could be tested compared with 49% of the children younger than 3 years (P<.001). Among those who were testable, for children younger than 3 years the sensitivity was 80% (95% confidence interval [CI], 44%-97%) and the specificity was 41% (95% CI, 24%-61%). For children aged 3 to 5 years, the sensitivity was 88% (95% CI, 68%-97%) and the specificity was 58% (95% CI, 43%-71%).

Conclusions  Our findings suggest that screening children aged 3 to 5 years with monocular autorefraction would identify most cases of visual impairment but would be associated with many false-positive results. For children younger than 3 years, testability was low and results were nonspecific.

Author Affiliations: Child Health Evaluation and Research Unit, Division of General Pediatrics (Dr Kemper) and the Department of Ophthalmology (Mss Keating and Jackson and Dr Levin), University of Michigan, Ann Arbor.

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